Xia Hong-Tian
Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
Gastroenterol Res Pract. 2020 Sep 15;2020:3432786. doi: 10.1155/2020/3432786. eCollection 2020.
The surgical method of complete/radical cyst excision plus Roux-en-Y hepaticojejunostomy remains the primary therapy and the only effective treatment for cystic dilation of the bile ducts (CDBDs). However, the incidence of long-term postoperative complications is still high, as is the reoperation rate, and the potential for postoperative malignant transformation still exists. In recent years, significant progress has been made in understanding the pathogenic mechanism and pathological changes of adult CDBDs. Based on which, the surgical procedures for CDBDs have been revised to further improve their effectiveness. The purpose of this review is to systematically summarize the latest concepts of the etiology and pathogenic mechanism and the pathological changes of adult CDBDs. Based on the findings of these clinical and pathological studies, a comprehensive theoretical system in the surgical treatment of CDBDs has been established, which corrects many previous theoretical misunderstandings. The specific surgical method for each type of CDBDs and the key technical notes are also described in detail. Using these principles, treatment outcomes for CDBDs can be significantly improved, and the current high complication rate, reoperation rate, and rate of postoperative malignant transformation can be reduced.
全膀胱切除加 Roux-en-Y 肝空肠吻合术的手术方法仍然是胆管囊性扩张症（CDBDs）的主要治疗方法和唯一有效治疗手段。然而，术后长期并发症的发生率仍然很高，再次手术率也很高，并且术后仍存在恶变的可能性。近年来，在理解成人 CDBDs 的发病机制和病理变化方面取得了重大进展。基于此，对 CDBDs 的手术方法进行了修订，以进一步提高其有效性。本综述的目的是系统总结成人 CDBDs 的病因、发病机制及病理变化的最新概念。基于这些临床和病理研究的结果，建立了 CDBDs 外科治疗的综合理论体系，纠正了许多以往的理论误区。还详细描述了每种类型 CDBDs 的具体手术方法和关键技术要点。运用这些原则，可以显著改善 CDBDs 的治疗效果，并降低目前较高的并发症发生率、再次手术率和术后恶变率。
